New Client Questionnaire

NEW CLIENT QUESTIONNAIRE

A warm welcome to you! I am fully committed to helping you achieve health and vitality in your life so that you can turn your goals and dreams into reality. You can be proud of yourself for having made this commitment to yourself and your wellbeing. In doing so you will begin to make significant shifts in your life path. I’m here to support you in this whole process so that you can begin to heal your body, mind, and soul. And, as with all of my clients, I want to see you truly thrive and enjoy life more than you ever have before!

Please know that it’s perfectly normal at times to have a down week and even feel uncomfortable about the new things that you are creating in your life. Change can be uncomfortable at times, but it’s when we get past our discomfort zone that we get to our possibility and our results. You and I will be busting through all the inner limits on the way to your own North Star.

As your coach I will be your biggest cheerleader and wellness mentor, but I will also challenge you if you need it. Ultimately I do believe that you know yourself best, so if something really isn’t working for you, I always recommend that you are open and honest with me. Coaching is about finding the solutions that work for you. I am honored to to be on this journey with you.

xoxo,Carrie

As we begin, it’s important for me to get a sense of how you view the world and yourself. Each person has his/her unique ways of perceiving and has a unique way of interacting with others.

The following questions are to help me get to know you better. They are designed to stimulate your thinking such that our time together will be as productive as possible. I suggest you ponder the questions for a few days as you compose your responses and keep in mind that there are no right or wrong answers, just whatever is true for you.

Please take all the space you need to respond thoughtfully and submit this form to me at least 24 hours before our first session.

*I recommend that you compose your answers in a separate online document or handwrite them and then input into this form. The website does not auto-save and your work could be lost if you attempt to fill it out over time.

Name *

Name

First Name

Last Name

WELLNESS GOALS

What are the biggest goals you want to achieve in the next 3-6 months?

LIFESTYLE GOALS

What are some key lifestyle changes you would like to implement/achieve?

WHAT ARE YOU TOLERATING?

We humans have learned to tolerate a variety of situations, behaviors in relationships (in ourselves and others), frustrations, unmet needs, lowered standards, and so on. Things that you put up with drain energy and divert focus from purpose. This could be in your physical environment (the broken drawer), your work environment (too many hours), your relationships (communication isn’t working), or perhaps your relationship to money (not enough).
What are you tolerating? Please take some time to write down the things that you are putting up with. Simply becoming aware of what you are tolerating will bring these parts of your life into the forefront and you will naturally begin resolving them. Discuss these with me. Let’s make sure that part of our overall plan includes how to eliminate these energy drains.

DREAM BIG

If there were no obstacles in the way, what dream would you like to make happen?

INSPIRATION

Think about one or two people you know who inspire you. What about them is inspiring?

CHILDHOOD HOBBIES

When you were a child, were there any activities that were so interesting to you that they could cause you to lose track of time (you had to be reminded to come home for dinner, go to bed etc.)? Please tell us about them.

TWO STEPS

What two steps could you take immediately that would make the biggest difference in your current situation? (Your health situation or area of least satisfaction in your life in general)

MOTIVATORS

How have you been motivated in the past to reach difficult goals, make difficult decisions, or do challenging things? How can we best utilize that motivator now?

CURRENT HOBBIES

Are there any activities in which you now participate (as an adult) that cause you to lose track of time? Please tell me about them.

RULES

If you could break any rule without consequences, what rule would you break?

BODY SAYING NO

What is your body saying no to?

BODY HEALING

What does your body need in order to heal? (You do not need to answer this question if you feel that your physical health is optimal.)

WHAT ELSE?

What do I need to know about you that will help me most in coaching you?